Moving abroad at any stage of life requires careful planning and a fair amount of courage. One of the first considerations for anyone contemplating this move should be how to pay for health insurance. Whether you’re a college student, a working professional with a family, or a retiree, your health is one of your greatest assets and it needs to be protected by some level of health insurance coverage.
Currently, if a U.S. citizen spends 330 or more full days in a calendar year outside the U.S., they’re exempt from having to maintain Affordable Care Act (ACA)-compliant health insurance. If you’re abroad for fewer days in a year, know that short term insurance, travel insurance, and expatriate health insurance plans are not ACA compliant and do not count toward maintaining Minimum Essential Coverage. Some visa types may require you to carry a certain level of health coverage.
With that in mind, here are some helpful options for health insurance coverage while living abroad.
Expats under 65-ish
If you’re moving to a foreign country for work, your employer’s health plan may travel with you, especially if they are a multinational employer. If this isn’t the case, you may qualify for the national health plan of your host country (if it has universal health care). Most likely, you’ll want to purchase an international expatriate health plan—also called a global or international medical health plan—which is a full-featured, U.S.-style policy. It is often the most comprehensive and reliable option.
An expat policy has the benefits of worldwide coverage, local referral and billing networks in over 180 countries, medical and emergency evacuations, maternity coverage, prescription drugs, and the option to include U.S. coverage for when you return, even just to visit. Premiums are based on your age and types of coverage selected. While an expat policy is typically more expensive than other health insurance options, it is usually guaranteed for life and is still less expensive than comparable U.S. health insurance.
Another option is a hospital insurance plan. This is arranged through a specific private hospital in your host country. It is not general health insurance—only treatment in that hospital is covered. This is a very affordable option, despite the limited coverage. It can be an option for those who plan to live very near a hospital and don’t plan on too much travel away.
Travel medical insurance is a third option for those looking to move overseas. It’s a lower cost option with guaranteed issue—no filling out an in-depth health history and coverage begins immediately. This also has the option of a $0 deductible, 100% coverage beyond a deductible (rather than having a copay), and the flexibility of accepting new policyholders if you don’t qualify for local or international insurance. However, it’s not intended to be long-term insurance and usually only covers emergency care. It’s best suited for extended travel, perhaps while investigating where outside the U.S. you’d like to live more permanently.
Retirees hoping to live their golden years in a foreign country have additional health insurance considerations. Medicare coverage doesn’t follow you outside the U.S., so you’ll need to purchase another health insurance policy, although you can return to the U.S. for eligible elective care covered by this government program. A private Medigap policy might offer some health care service coverage outside the U.S.
In general, you’ll find health insurance costs more affordable outside the U.S., especially if you settle in a country with a universal health care system. Be careful to understand any exclusions when it comes to the native health care system and non-nationals. Depending on your age and preexisting conditions, you may also have the option of purchasing an expat insurance policy.